Expressed emotion in first-episode schizophrenia and in ultra high-risk patients: results from the Programma2000 (Milan, Italy).
ABSTRACT Expressed emotion (EE) was examined in a large sample of families of patients with either first-episode psychosis (FEP) within the schizophrenia spectrum, or who met the criteria for ultra high-risk (UHR) of psychosis. The aim of our study was to determine the patterns and relationship of EE with the duration of untreated illness (DUI) or of untreated psychosis (DUP), as well as with illness severity. The sample used in our study included 77 FEP and 66 UHR families. The Camberwell Family Interview was used to assess EE. In both samples, about one-third of patients' families were classified as high EE, with emotional over-involvement (EOI) being the most frequent reason for a family to be classified as high EE. In FEP, higher EE correlated with longer DUI, and higher paternal EOI with longer DUP. DUI, however, was not found to correlate to EE in UHR patients. Severity of illness at the initial assessment did not relate to EE in either FEP or UHR families. Families of FEP and UHR patients were not found to differ in terms of the prevalence of a high EE rating, or of any of its subcomponents. The results of this study only partially support the hypothesis that high EE develops as a reaction to patient status. Patients from families with high EE could possibly benefit from interventions that are targeted at improving their resilience when dealing with problematic family environments.
- SourceAvailable from: Cristina Medina-Pradas[Show abstract] [Hide abstract]
ABSTRACT: The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and emotional over-involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives’ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives’ criticism was associated with positive, negative, and general symptoms. EOI was related with negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives’ attributions of blame toward the patient. Relatives’ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients’ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives’ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.Psychiatry Research 08/2014; · 2.68 Impact Factor
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ABSTRACT: Carer burden is high during First Episode Psychosis (FEP) and evidence suggests that this is a predictor of poor long-term outcome. However our understanding of factors associated with higher burden is poor. We propose that carers' cultural backgrounds and health belief models will influence their perceived burden of care, over and above that explained by severity of illness.BMC Psychiatry 06/2014; 14(1):171. · 2.23 Impact Factor
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ABSTRACT: The present study aimed to investigate possible differences in family environment among patients experiencing their First Episode of Psychosis (FEP), chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50 FEP and 50 chronic patients, as well as 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients. Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility, high criticism and burden appeared to be the outcome of psychosis and not risk factors triggering the onset of the illness. Furthermore, emotional over-involvement both in terms of positive (i.e. concern) and negative behaviors (i.e. overprotection) is prevalent in Greek families. Psychoeducational interventions from the early stages of the illness should be considered to promote caregivers׳ awareness regarding the patients׳ illness, which in turn, may ameliorate dysfunctional family interactions.Psychiatry Research 06/2014; 219:486-496. · 2.68 Impact Factor